Real-Time Image and Dose Guided Radiation Therapy System Development and integration of a real-time image- and dose-guided radiation therapy system is long overdue. Advanced Radiation Therapy has identified an opportunity and designed a single system that uses a common platform for imaging the target tissue in real-time, immobilizing the tissue, delivering radiotherapy, and registering the therapeutic dose. The system is designed primarily for radiotherapy of breast cancer following lumpectomy, but has the potential to be used for other indications. The design combines mammographic image guidance for immobilizing breast tissue between two parallel paddles to identify (localize) the target tissue and non- invasive brachytherapy applicators that are subsequently attached to the paddles for delivering the therapeutic dose. Thus, the patent pending system, for the first time, allows one to practice "... you see what you treat and you treat what you see and then you record what was treated." The design combines multiple treatment directions, each orthogonal to the previous treatment and delivers, under real-time image guidance, a stereotactic therapeutic dose to the target tissue without exceeding the dose tolerance of the intervening normal tissue (including skin dose). The quality of the dose from this non-invasive design is superior to other partial breast irradiation techniques: The dose is uniform throughout the target, homogeneous (no hot/cold spots with a dose homogeneity index of 1), is conformal to the designated tissue, and significantly reduces unintended exposure to neighboring organs (heart, lungs and the contralateral breast). The Phase I research program is designed to complement the extensive on- going pre-clinical streamlining of the system and help with confidence building in the approach. The project, when completed, is expected to have established the reliability, reproducibility, safety, and efficacy of the design for widespread clinical use. PUBLIC HEALTH RELEVANCE: The AccuBoost system represents a unique advancement in the development of an integrated breast brachytherapy treatment. This system provides the clinician assurance of both proper targeting and treatment of the lumpectomy cavity margin for patients electing Breast Conserving Therapy (BCT) through the use of a single platform for imaging, treatment and verification. This project addresses all procedural aspects starting from compatibility with the surgical procedure (imaging of surgical clips), through alignment, delivery of a conformal (tissue sparing) treatment as well as confirmation of treatment delivery. [unreadable] [unreadable] [unreadable]